Analysis of direct settlement of non-local patients′ medical insurance at a tertiary hospital in Tianjin

Abstract

Objective To analyze the patient information and hospitalization of non-local patients whose medical expenses will be directly settled with their local medical insurance network by a tertiary hospital in Tianjin, and to suggest on further development of direct settlement of medical insurance networking for non-local patients in Tianjin. Methods A retrospective analysis was made on the data of 1 068 non-local patients whose medical expenses were directly settled via medical insurance network from September 2017 to September 2018. Results The majority of non-local patients came from Hebei province, mostly over 51 years old; these inpatient focus on the renown key disciplines such as urology and cardiology; about a half of them were surgical patients; the proportion of patients with chronic diseases was high.These non-local patients in Tianjin feature higher age, more hospitalizations, lower self-paid expenses and lower overall hospitalization costs. Conclusions We should strictly control the referral system of non-local patients, strengthen medical support to areas of poor medical conditions, strengthen the hierarchical medical system; enhance the publicity of non-local patient online settlement and policy awareness, and simplify the filing process.It is also important to enhance network construction and data stability. Key words: Insurance, hospitalization; Direct settlement; Hierarchical medical system; Supervision and management